Dark Spots After Fraxel Treatment for Acne Scars... Help?

Question

Hi, In March I had my fourth Fraxel treatment on acne scars from the palomar Starlux 1540 laser. I had had Fabulous results until the last one. about 8 hours after the treatment I started developing blisters on both cheeks and my skin was a lot more red and swollen than the first 3 treatments. When the redness started to fade away I noticed some pigmented spots on both cheeks which were not there at all before. I have very fair skin, however I do have some native american history. What to do?

Lawrence Kass, MD · Answer

The dark spots are most likely a result of post inflammatory hyperpigmentation after the laser treatment. It would almost certainly respond to Tri-Luma cream applied once a day, 30 minutes before bedtime. Your treating physician would likely be willing to write the prescription for you. Good luck!

Michael A. Persky, MD · Answer

Hi KP,

	It sounds as if you were burnt by the Palomar 1540 Starlux (not a Fraxel laser, but rather a different fractionated laser), and now have hyperpigmented scarring.  Best to discuss this with your treating physician.  Ironically, one of the best treatments for this is laser.  Good luck and be well.

	Dr. P

Brian S. Biesman, MD · Answer

What you are describing sounds like it may represent post inflammatory hyperpigmentation, a disorder that usually responds well to time and medical management. You should consult with a qualified, experienced physician who performs a large number of laser treatments and is experienced in treating this condition.

Leyda Elizabeth Bowes, MD · Answer

Dear Writer, Your outcome after Fraxel can happen sometimes, but I want to reassure you that it always goes away with appropriate bleaching creams and strict sun protection. Your dermatologist may prescribe Triluma, or recommend a Compounding Pharmacy where they can formulate a stronger concentration of the bleaching cream, like: Hydroquinone 8%, tretinoin 0.025% and hydrocortisone 1%. This may be applied before bedtime, every night for eight to twelve weeks. Don't forget your sun protection, preferably with an agent containing titanium dioxide or zinc oxide. Discuss these recommendations with your dermatologist, and I am sure that working together you will find a solution for the hyperpigmentation. Good Luck!

Joel L. Cohen, MD · Answer

Topical steroids can be very helpful to help reduce the discoloration. Sometimes we compound this with pigment correcting/bleaching agents as well such as hydroquinone. In addition, chemical peels (especially glycolic or jessner's peels) might be helpful to help even out the pigment or you might need a different laser to help even out the pigment. And essential is very strict good sunprotection, consider covering the area with a physical sunscreen block such as zinc oxide or titanium dioxide (many have a skin tone tint) to ensure proper coverage into the UVA range which can otherwise lead to more pigmenation.

Jo Herzog, MD · Answer

I agree with Dr. Wasserman. See your dermatologist and they will decide whether a bleaching cream would be the best way to go. This is not unusual and usually does resolve with little or no treatment. Also, SUNSCREEN every morning and anytime you are out.

Daniel I. Wasserman, MD · Answer

Sorry to hear about your outcome.  It is difficult to know the cause without knowing the settings, but sometimes this happens.  First, I recommend having them evaluated by a dermatologist.  That being said, to explain what is happening, I can analogize it this way.  When the American went to the moon, they put a flag and said 'We were here'.  When there is inflammation of the skin due to heat (lasers, cooking oil, irons, etc), the inflammatory cells in the skin do the same.  They can stain the skin like that flag on the moon.  Most studies that have evaluated the use of these lasers in darker skinned individuals commonly report post-procedural pigmentation with an average persistence of 1 month.  I have personally seen it last longer and shorter.  My recommendation is to see a dermatologist to ensure that the areas are healing well and to inquire about the value of adding any bleaching creams which may expedite their resolution a bit.

	Good luck,

	dw

Dark Spots After Fraxel Treatment for Acne Scars... Help?

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